Precertification

What requires precertification?

Members using Options 2 and 3 do need precertification for all inpatient services and certain outpatient surgeries, services and procedures. The exception is if using the Cigna PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.

How do I receive precertification?

• Your physician, hospital, or authorized representative may obtain precertification for you. If using the Cigna PPO Network in Option 2 for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
• Contact Permanente Advantage at 888-567-6847 (TTY 711). Representatives are available from 8:30 a.m. to 10 p.m. EST, Monday through Friday. You may, however, request precertification 24 hours a day, seven days a week, especially for urgent requests.
• To learn more, visit www.kp.org/providers/kppa, or review the precertification section in your Evidence of Coverage (EOC)/Certificate of Insurance (COI) for details.

If you don’t obtain precertification for Option 2 or Option 3 services, and the services are deemed not medically necessary, you may have to pay the entire expense. You may also have to pay a penalty, have your benefits reduced, and not have the expenses apply toward your deductible. So it’s really important to get precertification. To learn more, review the precertification section in your Certificate of Insurance for details.